Provider Demographics
NPI:1881747624
Name:PRESTON PHARMACY INC.
Entity type:Organization
Organization Name:PRESTON PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-722-4248
Mailing Address - Street 1:8200 W CENTRAL AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-9503
Mailing Address - Country:US
Mailing Address - Phone:316-722-4248
Mailing Address - Fax:316-722-9389
Practice Address - Street 1:8200 W CENTRAL AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-9503
Practice Address - Country:US
Practice Address - Phone:316-722-4248
Practice Address - Fax:316-722-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-07819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5694140001Medicare ID - Type Unspecified